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Background and Aim: Children and adolescents account for approximately 14% of inflammatory bowel disease (IBD) diagnoses. At an appropriate age and level of development adolescents with IBD have their care transferred from the pediatric to adult clinical team during a process termed "transition". The study aim was to survey pediatric gastroenterologists throughout Australasia to identify commonality in the transition process to contribute to standardized guideline development. Methods: A descriptive survey captured key variables: transition clinic format, process and infrastructure, transition assessments, and guidelines. The survey was distributed electronically to 59 Pediatric Gastroenterologists throughout Australasia in January 2023. Results: Seventeen (29%) clinicians completed the survey: Australia 13 (76%). New Zealand 4 (24%). Thirteen (76%) respondents had access to a dedicated IBD transition clinic. Adolescents attended transition clinics 1–7 times, and the main processes transferred were: prescription provision, biologic appointments, and adult team contacts. Transition was first discussed age 13–15 years (53%), or 16–18 years (47%), with the main discussion topics including: continuing adherence (88%), smoking (59%), alcohol use (59%), recreational drug use (59%). Transition readiness assessments were done infrequently (24%). The minority (24%) used formal guidelines to inform the transition process, but 15 (88%) considered the development of a standardized Australasian guideline as beneficial/extremely beneficial. Conclusions: This survey highlighted that transition care for adolescents with IBD is variable across Australasia. Australasian guideline development may optimize the transition process for adolescents with IBD and improve their longitudinal outcomes. [ABSTRACT FROM AUTHOR]

Background: Despite the availability of evidence‐based inflammatory bowel disease (IBD) guidelines, suboptimal care persists. There is little published research assessing barriers to IBD guideline adherence. Aim: To identify barriers to IBD guideline adherence including gastroenterologists' knowledge and attitudes towards guidelines. Methods: An online cross‐sectional survey of 824 Australian gastroenterologists was conducted from April to August 2018, with 198 (24%) responses. A novel survey was developed that was informed by the theoretical domain's framework. Results: Confidence in guideline recommendations was high; however, referral to them was low. The European Crohn's and Colitis Organisation guidelines were referred to most commonly (43.6%). In multivariate analysis, significant predictors of frequent versus infrequent guideline referral were: high confidence in the guideline (odds ratio (OR) 7.70; 95% confidence interval (CI): 2.43–24.39; P = 0.001), and low (≤10 years) clinical experience (OR 3.62; 95% CI: 1.11–11.79; P = 0.03). The most common barriers to guideline adherence were not having time (62%), followed by guideline specifics being difficult to remember (61%). Low confidence was reported in managing pregnancy and IBD (34%) and loss of response to therapy (29%). High confidence was reported in managing immunomodulators; however, only 43% answered the associated knowledge question correctly. Conclusion: Although gastroenterologists have high confidence in guidelines, they use them infrequently, primarily due to specifics being difficult to remember and lack of time. Self‐reported confidence in an area of IBD management does not always reflect knowledge. An intervention targeting these barriers, for example, computer‐based clinical decision support tools, might improve adherence and standardise care. [ABSTRACT FROM AUTHOR]

The bread clip is one of the most insidious foreign body ingested. The bread clip poses a serious medical danger to patients yet may often fail to manifest itself clinically on initial ingestion. We present a case series of three patients with bread clips ingestions that were managed in the Gold Coast University Hospital, Queensland, Australia between 2020 and 2021. Bread clips are not always readily identifiable depending on imaging and the management of these patients will often require a multidisciplinary approach between the surgeons, gastroenterologists and radiologists. [ABSTRACT FROM AUTHOR]

Background: There is likely variation in approach and management of patient with EoE due to lack of standardized care and variation in guidelines. We aimed to identify current practices regarding diagnosis and treatment in children with eosinophillic esophagitis (EoE) in Australia and New Zealand (ANZ). Methods: Information on current diagnostic and management approaches for pediatric EoE was collected via an online survey sent to pediatric gastroenterologists (pGE) in ANZ. We performed a cross-sectional study of pGE using a 49-question instrument regarding evaluation, diagnostic, and therapeutic aspects of EoE between October 2019 and December 2019. Results: Eighty-five percent of the survey responders were from Australia, and 66% were academic. 30% pGE perform > 3 esophageal biopsies for diagnosis of EoE, 40% involve an allergist, 30% use a twice daily PPI trial, and 70% do not exclude other cause of esophageal eosinophilia. For management, only 3% use dietary elimination as an initial therapy, and 24% use less than the recommended doses of swallowed fluticasone. Forty-nine percent were likely to stop treatment in after remission is achieved for 12 months. The EoE endoscopic reference score (EREFS) was not routinely used (49%). Two-thirds of pGE are concerned about long-term effects of recurrent need of general anesthesia. Conclusions: Diagnostic and management strategies for EoE differed widely among pGE in ANZ, including in diagnostic biopsies, assessing competing causes of esophageal eosinophilia, initials selection of treatments, and maintenance strategies. This variability likely reflects continued uncertainty regarding optimal management strategies and stresses the need for pediatric-specific ANZ guidelines to standardize EoE care. [ABSTRACT FROM AUTHOR]

Background: Inflammatory bowel disease poses substantial challenges to travel. We aimed to investigate inflammatory bowel diseases (IBD)-associated challenges to travel, information-seeking behaviour and associated factors.Methods: We collected data on patients' demographics, disease characteristics, travel barriers, information-seeking behaviour and travel outcomes in UK, Australia, New Zealand and Israel (2016-2018). Summary statistics were used to describe the sample, whereas multivariate binary and nominal logistic regression were used to model the outcome variables.Results: Almost 75.4% (1878/2491) participants' data were analysed with 71.14%, 15.4%, 11.2% and 2.1% from UK, Australia, NZ and Israel, respectively (76.3% females, 48.2% 30-49 years old 58.8% Crohn's disease). About 7.7% of study participants sought medical advice/were hospitalised while overseas. About 43.8% cancelled/changed their plans due to IBD. The most common barriers were worry about toilet facilities (76.3%), cleanliness/sanitation (50.9%) and availability of medical care (41.1%). Only 60.5% sought travel advice; the most popular information source was IBD doctor/nurse (32.6%). Almost 32.6% of study participants did not get travel insurance that covered their IBD. Those who did not receive advice or found obtaining travel insurance difficult, were less likely to obtain travel insurance (P < 0.001). Participants who travelled for work were more likely to be hospitalised/seek medical advice overseas and not obtain travel insurance.Conclusions: We report a detailed investigation on the IBD-associated barriers while travelling abroad, common information-seeking behaviours and factors associated with worse outcomes. Importantly, patients from all the surveyed countries provided similar travel barrier and preparation habits, highlighting the consistent nature of the challenge. [ABSTRACT FROM AUTHOR]

Adherence to evidence-based management is variable in inflammatory bowel disease (IBD), which leads to worse patient outcomes and higher healthcare utilization. Solutions include electronic systems to enhance care, but these have often been limited by lack of clinician design input, poor usability, and low perceived value. A cloud-based IBD-specific clinical management software – 'Crohn's Colitis Care' (CCCare) was developed by Australia and New Zealand Inflammatory Bowel Disease Consortium clinicians and software developers to improve this. CCCare captures patient-reported disease activity and medical assessment, medication monitoring, cancer screening, preventative health, and facilitates communication with the IBD team and referring doctor. De-identified longitudinal data are stored separately in a clinical quality registry for research. CCCare was tested for feasibility and usability in routine clinical settings at two large Australian hospitals. Users' experience was evaluated with System Usability Scale (SUS). Value to clinicians and patients was assessed by qualitative feedback. Security was assessed by penetration testing. Users (n = 13; doctors, nurses, patients) reported good usability and learnability (mean SUS score 75 (range 50–95), sub-scores were 77 (50–94) and 68 (38–100), respectively). Patients reported better communication with clinical team and greater ability to track disease. Clinicians highlighted structured management plans, medication adherence, and centralised data repository as positive features. Penetration testing was passed successfully. Initial evaluation demonstrates CCCare is usable, secure, and valued in clinical use. It is designed to measure outcomes of clinical care, including efficacy, quality, cost, and complications for individuals, and to audit these at hospital and national level. [ABSTRACT FROM AUTHOR]

Paediatric gastroenterology in Australia has undergone remarkable changes over the more than six decades since Charlotte Anderson's pioneering work, and is now a well-established specialty in its own right. Australian paediatric gastroenterologists have made important contributions nationally and internationally. [ABSTRACT FROM AUTHOR]

The COVID‐19 pandemic, caused by the novel coronavirus SARS‐CoV‐2, has emerged as a public health emergency and challenged healthcare systems globally. In a minority of patients, SARS‐CoV‐2 manifests with a severe acute respiratory illness and currently there is insufficient data regarding the virulence of COVID‐19 in inflammatory bowel disease patients taking immunosuppressive therapy. This review aims to summarise the current literature and provide guidance on the management of inflammatory bowel disease patients in the context of the COVID‐19 pandemic in the Australasian setting. [ABSTRACT FROM AUTHOR]

Background and Aim: Adenoma detection rate (ADR) is an important quality metric in colonoscopy. However, there is conflicting evidence around factors that influence ADR. This study aims to investigate the effect of time of day and endoscopist background on ADR and sessile serrated adenoma/polyp detection rate (SSA/P‐DR) for screening colonoscopies. Methods: Consecutive patients undergoing colonoscopy in 2016 were retrospectively evaluated. Primary outcome was the effect of time of day and endoscopist specialty on screening ADR. Secondary outcomes included evaluation of the same factors on SSA/P‐DR and other metrics and collinearity of ADR and SSA/P‐DR. Linear regression models were used for association between ADR, time of day, and endoscopist background. Bowel preparation, endoscopist, session, patient age, and gender were adjusted for. Linear regression model was also used for comparing ADR and SSA/P‐DR. Chi‐square was used for difference of proportions. Results: Two thousand six hundred fifty‐seven colonoscopies, of which 558 were screening colonoscopies, were performed. The adjusted mean ADR (screening) was 36.8% in the morning compared with 30.5% in the afternoon (P < 0.0001) and was 36.8% for gastroenterologists compared with 30.4% for surgeons (P < 0.0001). For every 1‐h delay in commencing the procedure, there was a reduction in mean ADR by 3.4%. Using a linear regression model, a statistically significant positive association was found between ADR and SSA/P‐DR (P < 0.0001). Conclusions: Morning and afternoon sessions and gastroenterologists and surgeons achieved the minimum standards recommended for ADR. Afternoon lists and surgeons were associated with a lower ADR compared with morning and gastroenterologists, respectively. Additionally, SSA/P‐DR showed collinearity with ADR. [ABSTRACT FROM AUTHOR]

Background Iron deficiency ( ID) is often an indicator of underlying pathology. Early detection and treatment avoids long-term morbidity and allows for prompt iron repletion, avoiding ID anaemia ( IDA) and the need for blood transfusion. Aim To evaluate the management of ID in two internal medicine units (general medical ( GM) and gastroenterology ( GE)) in a large metropolitan hospital and compare it to international guidelines. Methods All consecutive inpatient admissions in the GM and GE units were retrospectively reviewed until 40 patients in each service were identified with anaemia and/or microcytic hypochromic blood counts. Patient records and electronic discharge summaries were then reviewed to assess the recognition, investigation and management of these abnormalities. Results Overall, only 60% (48/80) of the cases of microcytic hypochromic picture and/or anaemia were recognised. Cases were more likely to be detected under the GE unit, 77.5% (31/40) versus 42% (17/40) in GM ( P < 0.002). Of the 31 recognised GE cases, 28 (90%) were investigated further with iron studies and/or endoscopic procedures. ID was confirmed in nearly half (5/11) of those tested; however, only 2 of 5 received iron replacement. Among GM patients, only 11 of the 17 recognised cases (64%) were investigated further. Iron studies were performed in all 11, confirming IDA in 4 (36%), all of whom received intravenous iron. A faecal human haemoglobin test was performed in two GM patients and one GE patient. Conclusion There remains significant room for improvement in the recognition, investigation and management of ID in hospital practice in Australia. [ABSTRACT FROM AUTHOR]

Background Studies have suggested a diagnostic role for faecal calprotectin ( FC) in patients with gastroenterological disorders. Aim To investigate Australian gastroenterologists' ( GE) views on FC use and to elicit factors that affect physicians' choices. Methods Electronic surveys were sent out to 405 consultants and 34 registrars in Australia. Respondents who answered <50% of the survey were excluded. Results In all, 140 participants provided a >50% response; 73% reported using FC in their clinical practice. Factors cited by non-users in restricting their FC use included cost (24%), availability (47%) and familiarity (18%). Even among users, 69% cited funding as a major deciding factor; 98 and 86% of FC users believed that the test is a reliable method of differentiating between inflammatory bowel disease ( IBD) and irritable bowel syndrome ( IBS) and assessing for mucosal healing in IBD respectively. Of non-users, 78 and 58%, respectively, would use FC to differentiate IBD from IBS and assess for mucosal healing in IBD, if FC testing was Medical Benefits Schedule ( MBS) listed. Both users (79%) and non-users (68%) reported that use of FC to defer or avoid colonoscopies was likely if the test was MBS funded. Conclusion Australian GE endorse the use of FC to discriminate between IBD and IBS, to check for mucosal healing in IBD and to reduce colonoscopy rates. Absence of MBS funding is an important factor contributing to the lack of usage of FC, in addition to the lack of familiarity with FC testing and availability. [ABSTRACT FROM AUTHOR]

Aim: Although available data support a role for exclusive enteral nutrition (EEN) in children with Crohn's disease (CD), use of this therapy varies. The aim of this study was to define the patterns of use of EEN across Australia and to better understand the reasons for this variation. Methods: Using an existing email network, Australian paediatric gastroenterologists were asked to provide details of their attitudes towards, and use of, EEN in children. A questionnaire was designed to direct responses, with regard to use of EEN, to current EEN protocols and patterns of use. Results: Twenty-one replies were received (58% response). Although 12 respondents felt that EEN was an appropriate therapy for CD, only 8 regularly used EEN for their patients. Usage varied between states and within units. Current use was related to practitioners' experiences of EEN during their gastroenterology training. The concerns of those who did not recommend EEN included compliance, cost and resource demands. The doctors who recommend EEN reported that family support, team approach and disease location were important factors for a positive outcome from EEN. Current protocols varied in terms of type of formula, length of therapy and use of concurrent medications. Conclusions: Variations in care were illustrated across these paediatric gastroenterologists. Practitioners have many reasons and concerns about the use of EEN: these impede the wider use of EEN for paediatric CD. More consistent protocols for the use of EEN and an improved understanding of the mechanisms of EEN could lead to enhanced use of this therapy. [ABSTRACT FROM AUTHOR]

Background: Although faecal fat excretion over 72 h is the gold standard for quantifying fat malabsorption, there has been a push from chemical pathology laboratories to discontinue this test, arguing that it is unreliable and of limited clinical value. Aims: To assess attitudes, knowledge and practices of Australian gastroenterologists in relation to the test and to gauge opinion as to whether it should remain available. Methods: A self-administered questionnaire was developed to assess attitudes towards, patterns of use and understanding of 72-h faecal fat collections. This was posted to all members of the Gastroenterological Society of Australia. Results: Of 429 eligible gastroenterologists, 124 (29%) responded. Eighty-two per cent utilized the test; 62% at least once per year. Main indications were suspected steatorrhoea (55%), unexplained chronic diarrhoea (39%) or weight loss (29%). Thirty-eight per cent ordered the test to determine stool volume. Only 26% attempted to appropriately fat load patients and approximately half did not recognize the potential influence of medications and stool volume. This was also reflected in poor interpretation of results in specific clinical scenarios. Of those who use the test at least once per year, 97% wanted its continued availability and 51% felt their practice would be significantly affected if the test was discontinued. Conclusions: Although continued availability of 72-h faecal fat estimation is supported by many Australian gastroenterologists, the test appears to be often performed and interpreted suboptimally. Rather than discard the test, efforts should more appropriately be directed to improving baseline knowledge to ensure its optimal performance and interpretation. (Intern Med J 2006; 36: 77–85) [ABSTRACT FROM AUTHOR]

Background and Aim: Endoscopist directed nurse administered propofol sedation (EDNAPS) is widely considered to be safe and efficient, but there are limited data from the Australian health-care setting, and Australian sedation guidelines do not support the practice. Thus, we report data from a prospective audit of EDNAPS over a 6.5-year period in an Australian referral hospital., Methods: Consecutive endoscopic procedures performed between January 2013 and June 2019. Sedation protocol was an initial dose of midazolam 1-3 mg intravenously (i.v.) and propofol 10-50 mg i.v.. Further aliquots of propofol 10-30 mg i.v. were given as required. ProvationMD® endoscopic reporting system was used to prospectively record patient demographics, medication and dose, American Society of Anesthesiologist's (ASA) class, and sedation-related complications., Results: During the 78-month period, 28 051 eligible procedures were performed; 3093 procedures performed with anesthetic support or without EDNAPS were excluded. In total, 24 958 procedures with EDNAPS were analyzed including 7563 gastroscopies, 12 941 colonoscopies, 2932 gastroscopy and colonoscopy, 1440 flexible sigmoidoscopies, and 82 combined gastroscopy and flexible sigmoidoscopy. Of these, 9539 were ASA 1 (38.2%), 13 680 were ASA 2 (54.8%), 1733 were ASA 3 (6.9%), and 4 were ASA 4 (0.02%). Sedation-related complications occurred in 66 patients (0.26%), predominantly transient hypoxic episodes. No patient required intubation for an airway emergency, and there was no sedation-related mortality. Sedation-related complications increased with ASA class and were significantly more common with gastroscopy., Conclusions: Endoscopist directed nurse administered propofol sedation is a safe way of performing endoscopic sedation in low-risk patients in the hospital setting., (© 2020 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.)

The article presents the author's insights regarding the Australian Gastroenterology Week (AGW) 2012 to be held at the Adeliade Convention Centre on October 16-19, 2012.

The article offers information on the efforts of some hospitals in Australia to make their patients happy during Christmas. It mentions about the practice of gastroenterologist Andrew Brett to dress like Santa Claus and have a special visit to the Royal Melbourne Hospital. The author also talks about the Christmas party held by the staff, families and patients at the Royal Children's Hospital in Brisbane, Queensland.

The author offers his view on the 50th anniversary of the Gastroenterological Society of Australia (GESA) special edition which reflects on the contributions of Australians to global knowledge in Gatroenterology and Hepatology. He attributes GESA's success to the principles of dedication to professional service, commitment to best clinical practice and furthering clinical research. He points out that the future of the society depends on its young members.